More than thirty years have passed since the first “revolution in mental health”—the deinstitutionalization movement that moved patients out of segregated mental health hospitals and, in theory, back into their neighborhoods to be with their families. But a generation later, many are still waiting to receive basic care in their communities—the therapy they require to live with the dignity and freedom the movement fought for.
Earlier this month, mental healthcare workers across California went on strike to show that everyone’s tired of waiting—patients are tired of delayed appointments, workers are exhausted by understaffing and stalled contract talks, and the system suffers from an outmoded infrastructure that fails to meet growing community needs.
Clinicians at the healthcare and insurance giant Kaiser Permanente simply want the company to follow the law: California’s relatively progressive mental health parity regulations mandate that providers offer mental health services “under the same terms and conditions applied to other medical conditions.” Meanwhile, the added insurance resources of the Affordable Care Act have raised hopes for reform.
But Jim Clifford, a psychiatric social worker at a Kaiser center in San Diego, one of thirty-five locations that went on strike statewide says that due in part to the “stigma associated with mental health,” the field has been marginalized, leading to a “relegation at Kaiser of psychiatric services to this second-class level.”
At his clinic, serving a diverse urban population, the staff must stretch to make ethically impossible choices: “We are staying late making phone calls back to patients that we weren’t able to get appointments for, to check in and see how they’re doing. The doctors have to double and triple book their schedules. The nurses usually are here before they’re on the clock and typically stay well past their paid time to try to catch up to all the extra contact that’s made necessary by the fact that we don’t have enough staffing.”
Elizabeth White, a psychiatric social worker at Kaiser West Los Angeles, tells The Nation that facing a staffing and space shortage at her facility, “the manager’s been really creative at turning closets into offices, and partitioning group rooms. But the main piece is [Kaiser regional management] really haven’t thought through their demand, to create an environment that is healing…. At five o’clock we have three different [therapy] groups starting, and the line’s out the door.”